Although glucose intolerance and/or overt diabetes are common in cirrhotic
subjects, the mechanism(s) that lead to post-prandial hyperglycemia in cirrhosis
are not entirely known. To this aim, we measured whole-body rates of glucose
appearance (Ra) and of disappearance (Rd) in cirrhotic-diabetic subjects and in
controls, before and following a 4-hr administration of a mixed meal. In the
post-prandial phase, endogenous and dietary glucose Ra, as well as first-pass
splanchnic uptake of dietary glucose, were measured using a double (ie oral and
intravenous) glucose tracer technique. In the fasting state, the cirrhotic
patients were hyperglycemic (12.0 +/- 1.4 vs 4.4 +/- 0.2 mmol/l in controls, p <
0.001), had a higher glucose Ra (17.0 +/- 2.7 vs 10.2 +/- 0.5 micromol x kg(-1) x
min(-1), p < 0.05) and a lower clearance rate (1.51 +/- 0.19 vs 2.32 +/- 0.06 ml
x kg x min, p < 0.02). Following the meal, plasma glucose increased to greater
values (p < 0.002) in the patients (to 16.8 +/- 2 mmol/l, mean values of the last
40 min) than in the controls (to 7.2 +/- 0.4 mmol/l). Insulin increased in both
groups but it was 35% lower (p > 0.05) in the patients. Post-prandial total
glucose Ra (cirrhotics: 21.3 +/- 2.6; controls: 19.2 +/- 1.4 pmol x kg(-1) x
min(-1)), endogenous Ra (cirrhotics: 7.3 +/- 1.5; controls: 7.0 +/- 1.3 micromol
x kg(-1) x min(-1)) and first-pass splanchnic uptake of dietary glucose
(cirrhotics: 9.8 +/- 2.6; controls: 11.5 +/- 1.6 micromol x kg x min(-1)), were
not different between the 2 groups, whereas glucose clearance remained lower
(p<0.001) in the patients (1.31 +/- 0.25 ml x kg(-1) x min)-1)) than in the
controls (2.72 +/- 0.26). These data demonstrate that, in cirrhotic-diabetic
patients, post-pran-dial hyperglycemia is not due to a reduced extraction of
dietary glucose nor to an increased endogenous production, but rather to a defect
in peripheral glucose clearance, secondary to either insulin-resistance and/or
relative insulin deficiency
